Dog Bite Treatment (cont.)

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

What is the treatment for a dog bite?

There are three important treatment issues that need to be addressed with a dog bite:

the skin damage

injury to underlying tissues such as muscle, nerve, and bone;

and infection.

It is easy to look at a dog bite and see that the skin has been damaged, but it is also important to assess the underlying structures that may have also been injured in the attack. The patient often concentrates on the cosmetic appearance of the wound; while that is important, the health care practitioner may be more concerned about the injuries that will impair the body's function. For example, a laceration to a hand may look bad, but more important than the potential scarring would be a lacerated tendon that would prevent a finger from moving.

The potential for infection is also of great importance. Dog bites inoculate bacteria deep into tissue, and while not as aggressive as cat bites, the majority of dog bites do get infected. Common bacteria involved in such infections include Streptococcus,
Staphylococcus, and Pasteurella.

Rabies is always a concern, and it is important to know the dog's immunization status. If the dog has not been immunized, the question becomes whether to immunize the patient against the rabies virus. A variety of approaches may be considered depending upon the situation surrounding the bite.

Is the dog available to be observed?

Was the bite provoked or defensive rather than an unprovoked attack?

Where is the bite located?

What is the past medical history of the victim?

Once the health care practitioner has taken a history of the events and examined the patient, most dog bites can be cared for in the emergency department or doctor's office. The physical exam will help decide whether any deep structures like muscle, tendon, nerve, or bone have been damaged.

Commonly, the wound is anesthetized so that it can be explored. This will help confirm the condition of the deep structures and their function. The wound will then be washed with normal saline (a salt water solution) to irrigate out as much dirt and bacteria as possible.

Once the wound has been cleaned, a decision needs to be made whether to close the skin. Suturing the skin
(to make the scar look better) increases the risk of infection. Balancing the risk of infection against the benefit of a better looking scar depends upon the location of the injury and the discussion between health care practitioner and patient. Dog bites to the face tend to be sutured, while those located on less noticeable parts of the body may be left to heal on their own.

Sometimes, the dog bite wounds need to be repaired in the operating room if there is considerable skin damage or skin loss, or if there are associated injuries that require treatment.

With infants and children, the decision may be considered to repair their lacerations in the operating room, especially if facial wounds are involved, because of the need for prolonged anesthetic to keep the patient still.

There is some controversy regarding antibiotic therapy for dog bites. Some health care practitioners routinely prescribe antibiotics while others choose to wait until the wound shows signs of potential infection.